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qÜÉ=aá~ÄÉíÉë=a~ëÜÄç~êÇ= Diabetes is a condition where the amount of glucose in the blood is too high because the body cannot use it properly. This is because the pancreas does not produce any insulin, or not enough, to help glucose enter the body’s cells – or the insulin that is produced does not work properly. There are 2.8 million people diagnosed with diabetes in the UK and a further estimated 850,000 people who have the condition but have not yet been diagnosed. Nine billion pounds a year is spent on treating diabetes and its complications, and this accounts for about 10 per cent of total NHS spending. There are two main types of diabetes. Type 1 diabetes, a non-preventable condition, is when no insulin is produced at all because the insulin-producing cells in the pancreas have been destroyed. Type 2 diabetes is when the body either does not produce enough insulin, or the insulin it produces does not work as well as it should (insulin resistance) and this type of diabetes can be controlled by the patient through lifestyle changes. The Diabetes Dashboard has been created by the Quality Observatory to help identify areas for improvement in diabetes care. A range of indicators are displayed from both primary and secondary care that together help describe the current status of diabetes services across practices and GP Commissioning Consortia (GPCC) in the South East Coast region. It can also help in finding other localities that are performing particularly well. Key diabetes QOF indicators: exception rates
12% 10% Key diabetes QOF indicators: underlying achievement
8%
100%
6%
90%
4%
80%
Diabetic em ergency adm issions (per 10,000 population) and com plication rate 70%
100%
1.2
2% 60%
90%
All emergency diabet es admissions
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20% 10%
All emergency diabet es admissions: SHA
%admissions wit h complicat ions
%admissions wit h complicat ions: SHA
Mar-11
Jan-11
Feb-11
Nov-10
Dec-10
Oct-10
Sep-10
Jul-10
Aug-10
Jun-10
Apr-10
May-10
Mar-10
0% Jan-10
Nov-09
SHA
Record of retinal screening in the previous 15 months
0
Dec-09
Consort ia
30%
Last blood pressure is Diagnosis of proteinuria Cholesterol within the 145/85 or less 0.2 or micro-albuminuria previous 15 months is treated with ACE 5mmol/l or less inhibitors (or A2 antagonists)
Oct-09
Pract ice
HbA1c is 7 or less
40% 0.4
Sep-09
BMI recorded in the previous 15 months
50%
Jul-09
0%
60%
0.6
Aug-09
10%
70%
Jun-09
SHA
80%
Record of retinal screening 0.8in the previous 15 months
Apr-09
Consortia
Last blood pressure is Diagnosis of proteinuria Cholesterol within the 40% 145/85 or less or micro-albuminuria previous 15 months is treated with ACE 5mmol/l or less 30% inhibitors (or A2 20% antagonists)
May-09
Practice
HbA1c is 7.5 or less
% with complications
BMI recorded in the previous 15 months
1
Feb-10
50%
Number of admissions/10,000
0%
qÜÉ=aá~ÄÉíÉë=a~ëÜÄç~êÇ=áåÇáÅ~íçêë= Information relating to both primary and secondary care is included in the Diabetes Dashboard
The Primary Care charts display information relating to 6 key QOF diabetes indicators, and include Underlying Achievement and Exception Rates. Using drop-down menus you can select your desired GPCC and, within that, your chosen practice. Results for the SHA are also shown as a benchmark. There are currently three years worth of QOF data available in the dashboard.
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The QOF indicators displayed are: • • • • • •
BMI recorded in the previous 15 months HbA1c is 7 or less (7.5 prior to 2009-10) Last blood pressure is 145/85 or less Diagnosis of proteinuria or micro-albuminuria treated with ACE inhibitors (or A2 antagonists) Cholesterol within the previous 15 months is 5mmol/l or less Record of retinal screening in the previous 15 months
For reference, the QOF exception criteria are given. Also included for Primary Care is QOF vs estimated diabetes prevalence, against the regional (SHA area) figures.
Here you can select a GPCC and see various performance measures related to secondary care for diabetes. Data is displayed either monthly or on a rolling 12 month basis and there is also an option to see the SHA figures again for benchmarking purposes.
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The secondary care indicators are: • • • • •
Total diabetic emergency admissions (per 10,000 population) and complication rate Diabetic admissions with complications per 10,000 population (see below) Average length of stay for emergency diabetic admissions Estimated PbR spend on all diabetic admissions per 10,000 population Admissions for diabetes in pregnancy per 10,000 women aged 15-44 years
The second chart relating to emergency admissions with complications allows you to select from six different diabetes-related complications and see trends for your GPCC. These are coma, ketoacidosis, renal, ophthalmic, neurological and peripheral circulatory complications.
The dashboard is designed to be used as a tool alongside local knowledge and understanding of the diabetes landscape. Included in the tool is a guide on how to use it, which also describes the data sources used and the methodology employed to calculate the indicators. It can sit alongside the Quality Observatory’s other long terms conditions dashboards including the COPD suite of tools and the high-level QIPP dashboard relating to all long term conditions.
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_ÉåÅÜã~êâáåÖ= kÉíïçêâáåÖ= `çää~Äçê~íáçå= aÉîÉäçéãÉåí=çÑ=jÉíêáÅë= aÉîÉäçéãÉåí=çÑ=pâáääë= aÉîÉäçéãÉåí=çÑ=qççäë= pí~íáëíáÅ~ä=qÉÅÜåáèìÉë= mêÉëÉåí~íáçå=C=fåíÉêéêÉí~íáçå= a~í~=pçìêÅÉë=C=`çääÉÅíáçåë= Quality Observatory NHS South East Coast York House 18-20 Massetts Road Horley,Surrey, RH6 7DE Phone: 01293 778899 E-mail: Quality.Observatory@SouthEastCoast.nhs.uk Website: www.QualityObservatory.nhs.uk To contact a team member: firstname.surname@southeastcoast.nhs.uk
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